Provider Demographics
NPI:1962665802
Name:AMPUTEE SUPPLIES INC
Entity type:Organization
Organization Name:AMPUTEE SUPPLIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTOK
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:805-341-6889
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-1299
Mailing Address - Country:US
Mailing Address - Phone:323-306-4981
Mailing Address - Fax:
Practice Address - Street 1:800 MCGARRY ST STE 323
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1950
Practice Address - Country:US
Practice Address - Phone:323-306-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6154580001Medicare NSC